| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,331 |
1,646 |
$259K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,242 |
1,431 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
1,822 |
1,631 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,965 |
2,864 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,434 |
943 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
947 |
677 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,805 |
1,701 |
$42K |
| D1110 |
Prophylaxis - adult |
1,218 |
1,190 |
$42K |
| D1120 |
Prophylaxis - child |
2,061 |
1,984 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
2,275 |
2,207 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,145 |
2,063 |
$33K |
| D0274 |
Bitewings - four radiographic images |
877 |
859 |
$17K |
| D2335 |
|
176 |
125 |
$17K |
| D0330 |
Panoramic radiographic image |
263 |
251 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,333 |
2,020 |
$11K |
| D2331 |
|
131 |
92 |
$8K |
| D0272 |
Bitewings - two radiographic images |
679 |
655 |
$7K |
| D2332 |
|
67 |
52 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
72 |
50 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
660 |
224 |
$3K |
| D2330 |
|
52 |
37 |
$3K |
| D4341 |
|
28 |
13 |
$3K |
| D2394 |
|
32 |
28 |
$3K |
| D1206 |
Topical application of fluoride varnish |
105 |
103 |
$1K |
| D2160 |
|
16 |
12 |
$1K |
| D1999 |
|
412 |
366 |
$0.00 |